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          <div style="float: right;">Logged in as: <a href="#">Meskerem Asfaw</a></div>
        <h3 class="muted">Personal health assessment questionnaire</h3>
        <br />
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                <span>40% Complete</span>
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		<legend>3. Bleeding disorders </legend>
                <div class="alert alert-info"><b>Example:</b> Blood clots, haemophilia, easy bruising / nose bleeding.</div>
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                                    <button class="btn btn-default" type="button">No</button>
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                        <td width="10%"></td>
                        <td>
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                                <span class="input-group-btn">
                                  <button class="btn btn-default" type="button">Yes</button>
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                                  <input type="text" class="form-control" placeholder="If yes, please specify here...">
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